COPD reduces chances of survival and increases health care costs after surgery, study finds

One study found that patients diagnosed with chronic obstructive pulmonary disease (COPD) were 61% more likely to die in the year following surgery and had a 13% increase in health care costs after surgery, compared to patients without COPD.

“Since COPD patients are often frail and have many health problems, their management during the time of surgery should address not only the COPD but all their health problems,” Ashwin Sankar, MD, MSc, FRCPC, anesthetist at St. Michael’s Hospital, a site of Unity Health Toronto and the University of Toronto, it said in a statement.

This population-based retrospective cohort study examined the long-term postoperative survival and healthcare costs of patients with COPD compared with those without COPD. The results were published in Journal of the Canadian Medical Association (CMAJ).

Researchers identified a total of 932,616 patients 35 years of age and older residing in Ontario, Canada who underwent select intermediate-to-high-risk inpatient elective noncardiac surgeries from 2005 to 2019, including total hip replacement. or knee, gastrointestinal surgery, vascular surgery, etc.

The researchers followed the participants for 1 year after surgery to assess survival rates and healthcare costs. Sociodemographic factors were taken into account in the analysis. Frailty, cancer, and procedure type modified the association between COPD and outcomes.

Previous estimates have suggested that over 10% of surgical patients have COPD. In this study, of all identified patients, approximately 1 in 5 (170,482) had COPD. These patients tended to be older (between the ages of 62 and 78), male, frail, on lower incomes and with pre-existing conditions such as coronary heart disease, diabetes and lung cancers.

Patients with COPD were 61% more likely to die (n = 5873, 3.4%) compared with those without COPD (n = 9429, 1.2%) within the year of the intervention. COPD had a partially adjusted hazard ratio (HR = 1.61; 95% CI, 1.58-1.64) and a fully adjusted hazard ratio (HR = 1.26; 95% CI, 1.24- 1.29).

In addition, 52,021 (5.6%) patients died the year after surgery, including 18,007 (10.6%) patients with COPD and 34,014 (4.5%) patients without COPD.

Additionally, COPD was associated with a 13.1% (95% CI, 12.7%-13.4%) partially adjusted relative increase in health care costs and a 4.6% (95% CI, 4 .3%-5.0%) with a full adjustment .

The researchers acknowledged that identifying patients undergoing surgery may have led to errors in their results and supported further studies to measure and define severe COPD in patients.

Overall, this study suggests that COPD patients have a higher risk of death and higher health care costs within the year following surgery. Additionally, the increased risk and cost associated with COPD was found to extend well beyond the immediate 30-day perioperative period and is influenced by frailty, cancer, and types of surgery, suggesting a need for improved postoperative care management for patients with COPD.

“Patients with COPD typically have comorbidities, biopsychosocial problems, and frailty,” the researchers wrote. “Our findings highlight the importance of careful risk prediction and decision making for COPD patients considering surgery.”


Sankar A, Thorpe K, McIsaac DI, Luo J, Wijeysundera DN, Gershon AS. Survival and healthcare costs after elective inpatient surgery: Comparison of patients with and without chronic obstructive pulmonary disease. Journal of the Canadian Medical Association. 2023;195(2). doi:10.1503/cmaj.220733

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